Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data

Abstract

Background This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. Methods We linked multiple cycles (2005–2006, 2007–2008, 2009–2010, 2011–2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship. Results Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services – e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions. Conclusions Strong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service use in those with multimorbidity. The study’s results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors.

Emergency hospital admissions among older adults living alone in the community

“…Older adults are increasingly living alone [12], which is associated with a higher risk of ED admissions [13][14][15][16], longer inpatient days [17][18][19][20][21][22] and higher inpatient costs [19]. Since older adults living alone are not able to draw support as immediately as those living with others, they could rely more on acute tertiary services when emergencies arise [23][24][25].…”

Analysis of Healthcare Expenditures in Bulgaria

“…The relationship between the degree of multimorbidity and healthcare expenditure depended on age, sex, and income in both age groups [ 16 , 17 ]. The number of emergency department visits and hospitalizations increases for patients with multimorbidity, and healthcare costs increase toward end of life [ 30 ].…”

Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis

“…As people everywhere live longer, there will be dramatic increases in the prevalence of many chronic conditions—due to multiple underlying factors—that tend to occur later in life [ 1 ]. Older people living with chronic conditions often present with a functional decline that leads to them becoming significant users of healthcare services, particularly acute care [ 2 , 3 ]. Between 2010 and 2015, hospitalizations in Switzerland of people aged 60 years old or more increased by 11.6% for men and 9.0% for women [ 4 ].…”